Eliminated thousands of provider calls and scaled from 1 to 6 trading partners in just 12 months

According to the CAQH Index Report, every year U.S. healthcare spends nearly $440 billion on manual administrative tasks like eligibility checks and claim status updates. In fact, CAQH highlights that fully adopting electronic eligibility and benefits verification alone represents about $12.3 billion in potential annual savings. Real-world examples confirm this potential and have reported freeing over 15,000 employee-hours per month by applying AI-powered automation to billing and eligibility tasks (Business Insider). Together, these insights underscore the scale of opportunity for payers who embrace automation.

The Challenge

A rapidly growing health plan focused on delivering a seamless digital experience for providers and members. As their provider network expanded, quick and reliable access to eligibility information became a top priority.

They faced two major barriers:

• Manual Burden: Providers often relied on phone calls and faxes for eligibility checks, creating unnecessary administrative costs and delays.
• Scalability: With limited electronic transaction volume, 32 eligibility (270/271) transactions in August 2024 and only one active trading partner, they needed a solution to scale quickly and efficiently.

The Solution

To address these challenges, the health plan expanded its partnership with Smart Data Solutions to expand beyond claims transactions (837) into eligibility automation (270/271). Smart Data Solutions delivered:

• Rapid Trading Partner Onboarding – Seamlessly scaled active trading partners from 1 to 6 in just 12 months.
• Transaction Growth – Expanded 270/271 transaction volume from 32 in August 2024 to 10,013 in August 2025.
• Operational Efficiency – Automated manual eligibility checks, to reduce call center volume and provider friction.

The Results

• Eliminated Thousands of Calls: With provider eligibility calls estimated at $5–$7 each, converting ~10,000 checks into electronic transactions represents an estimated annual savings of approximately $60,000 in manual processing costs for the health plan.
• Explosive Growth: Rapid and significant increase in transaction volume, this also demostrated Smart Data Solutions’ ability to support rapid scaling.
• Improved Provider Experience: Provider gained faster access to eligibility information reducing frustration and enhancing payer–provider trust.
• Internal Efficiency Gains: Fewer calls and disputes allowed staff focus on higher-value work.

Conclusion

The health plan’s partnership with Smart Data Solutions shows how payers can quickly scale electronic transactions, onboard new partners, and reduce hidden costs from provider friction.

By expanding beyond 837 claims transactions into eligibility automation, they achieved measurable savings, improved provider satisfaction, and strengthened its network relationships within a single year.

Are your curious how much your organization could save by automating eligibility transactions?

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